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APPLICATION FOR ENCROACHMENT PERMIT <br />PLEASE PRINT: <br />Date 12/11/2015 <br />To:San Joaquin County <br />Departmentof PublicWorks <br />AT&T I Sherry Parks (Permits Desk) <br />(Applicant Name) <br />5555 E.Olive Ave <br />(Mailing Address) <br />Fresno,CA93727 <br />(City,Slale,Zip Code) <br />(559)454-4900 g26977@att.co <br />(Area Code.Telephone Number) <br />OFFICE USE ONLY <br />JOB#73007Q REF# <br />APN CR# <br />EXP.DATE ?-1-16 <br />VALID }-)6-t TO :l.(.16 DRIVEWAYS: <br />STREET •{}"Lt <br />AREA Thor",QUAD Nv;/. <br />TYPE ICP . <br />FORMS 55 h/JIV <br />NOTES <br />11 <br />Sketch(Detailed plans may besubmitted) <br />Please refer to the attached drawings. <br />The undersigned herebyappliesfor permissionto excavate,construct and/orotherwiseencroachon County HighwayRight-of-Way on <br />the West side of Oak St.approximately 138 feet/mile feet <br />of N Sacramento Bl ve ,~,by performingthe followingwork (description of work): <br />Traffic control plan is in place for pole access with aerial street crossing. <br />Work will commenceon or about 12/18/2015 for approximately 5 days. <br />I,the undersigned,certifythat I am the owner of the respectiveproperty,or am qualified to representthe owner and agree to do the <br />work described above in accordancewith the rules and regulationsof SanJoaquin Countyand subject to inspection and approval. <br />P'+..I .E,.N C.\AI €:.ER.;NG..lU--V\vV\(J""IA:V\..lUl ADM ~N itl«M Q f:-. <br />Signature of Applicant.Title <br />1"Z.-\i-2.0\~ <br />Date